What we discovered about the long-term care homes in your community

The COVID-19 pandemic exposed a harsh truth about Ontario’s long-term care homes: many were woefully understaffed, a factor that helped fuel the rapid spread of the deadly virus.

Doug Ford’s government promised a major overhaul, including this key goal: by the end of 2024-25, LTC homes would have enough staff that each resident would receive an average of at least four hours a day of direct “hands-on care” from nurses and personal support workers (PSWs).

As it worked toward that goal, the government crunched the numbers and regularly disclosed the provincial average. Although Ontario just missed its final target — recording an average of 3 hours and 49 minutes of hands-on care in the fourth quarter of the 2024-25 fiscal year — it exceeded the four-hour mark the following quarter.

But data on individual homes’ performance has not been made public. Until now.

The Trillium, Village Media’s bureau at Queen’s Park, obtained the internal government data via a freedom of information request. The exclusive report includes a searchable tool that anyone can use to access the data regarding their local long-term care homes.

Jessica Smith Cross, editor-in-chief of The Trillium, is our guest on tonight’s episode of Closer Look.

Along with her investigative report, we also talk about The Trillium's ongoing crowdfunding campaign related to the Ford government's Skills Development Fund (SDF). You can find out more about that project HERE and HERE.

Hosted by Village Media’s Michael Friscolanti and Scott Sexsmith, and produced by Derek Turner, Closer Look is a new daily podcast that goes way beyond the headlines with insightful, in-depth conversations featuring our reporters and editors, leading experts, key stakeholders and big newsmakers.

Fresh episodes drop every Monday to Friday at 7 p.m. right in your local news feed — and on the show’s dedicated website: closerlookpodcast.ca. Of course, you can also find us wherever you get your favourite podcasts.

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Transcript

SPEAKER_00: 0:00

Uh, you'll remember that things got so bad in some Ontario long-term care homes that the Canadian military was called in, which is a remarkable and terrible thing. And the things that they found were awful.

SPEAKER_01: 0:38

Derek Turner, uh also in the room, by the way, uh producing this evening's uh program. We talk a lot, and we talked about this last week, uh, about health care uh on this program, and tonight's episode is certainly uh no different.

SPEAKER_02: 0:50

Yeah, but I look back at the list of episodes we've done since we officially launched, though there have been a lot of healthcare ones, but it's because it's a big issue that we talk about. Today's no different. We're gonna talk about um the care that people are receiving at long-term care homes. Sort of the 10,000-foot version is that we knew from COVID that there were all kinds of problems. You remember just the horror stories coming out of long-term care homes during COVID, not just the fatalities of people dying, but just the conditions that people were reporting. Um and there was a brutal report done by the Canadian military that actually went in to help at some of these things, just talking about how bad it was. And so the government announced changes, they legislated those changes, and they've been measuring those changes. Um, and they all deal with kind of the amount of hands-on care that a patient is getting throughout the day. Um and we're gonna talk to Jessica Smith Cross, who's our editor-in-chief at the Trillium, our bureau at Queen's Park, uh, because they're not busy enough with the stuff they've doing with the Skills Development Fund, all their great reporting on that. But Jess dug up some some data that took you know more than a year to get this data via Freedom of Information just about how nursing homes are measuring up to the new rules that are in place. And it's fascinating. I don't want to spoil it because I want to get it let her unveil it, but it but it's fascinating and it it's scary at the same time.

SPEAKER_01: 2:03

If the COVID-19 pandemic revealed anything, it's that the province's long-term care homes needed a major overhaul, with staffing levels at the top of the list. The Ford government made some big promises, and years later, we have a better idea of how one of those promises is panning out. Joining us tonight to explain all the details is Jessica Smith Cross, our editor-in-chief at the Trillium, our bureau at uh Queen's Park. Uh Jess, always a pleasure.

SPEAKER_00: 2:29

Hi guys, always good to see ya.

SPEAKER_01: 2:31

Okay, uh Jess, you just published uh yet another excellent piece of investigative journalism uh that took many months and likely uh lots of patients too uh to put together. It's all about the amount of hands-on care that patients are receiving in long-term care homes across the province. Now, we want to dig into all the details that you've uncovered, but let's begin with some background here. During COVID, the province learned a hard lesson about long-term care homes. What was it?

SPEAKER_00: 2:58

Staffing matters and it matters a lot. So when COVID started going through long-term care homes, some homes like it was hard. It was hard on all of the people who live there and all the people who work there, but some homes managed it better than others. Uh, you'll remember that things got so bad in some Ontario long-term care homes that the Canadian military was called in, which is a remarkable and terrible thing. And the things that they found were awful. Uh, the fallout of that is still going on. There are court cases across the province related to some of the experiences that happened. But what came out of it from the government's perspective was an acknowledgement that the staffing really does matter. And so the government promised that all long-term care homes would give residents an average of uh four hours of what they call hands-on care a day, um, and that they would fund them in order so that they can do that. And so, what that means is that in the long-term care home, there will be enough nurses and personal support workers specifically, so that their working time equals four hours per resident per day. It's not like exactly every resident gets four hours. It's an average, uh, and uh some residents have higher needs than others, though in long-term care, the needs are are pretty high, right?

SPEAKER_02: 4:16

I see. Oh, so it's really like a division question. This is how many staff we have, this is how many patients we have. So it equals that they each get four hours. Okay, that's clear.

SPEAKER_01: 4:23

Uh Jess, the government uh has been releasing some data about the uh progress that homes are making on this front. How detailed is the data that they've been releasing?

SPEAKER_00: 4:32

So the province has voluntarily been re-releasing like a province-wide average. So if you take all of the hours personal support workers and nurses work in province in the whole province's long-term care homes and divide them by the number of resident days or days any residents spend in any long-term care homes, this is how we're doing. Are we going to get the whole province uh to the four hours a day goal? Uh and what that has said is the province did make its goal. It was a few months later than it planned to do, which was about a year ago. Um, but it got there. And it has been put, it has put in billions of dollars to increase the funding to pay for these staff to do that. But what the province had refused to do uh was release data on individual homes. So there are all kinds of long-term care homes in Ontario, and we knew that it would be not every home was making this goal. Some homes outperformed it, bringing up the average, and some homes didn't make it for lots of different kinds of reasons. So uh what I did was do a Freedom of Information Act request. This is where we can request documents from the government, pay some money, wait some time, and get them because they're public information. And this data that I got was the home by home breakdown, how many nurse and personal support worker hours each quarter, so uh quarter year, uh, and then uh how many resident hours. And you can do the math and see who's doing what. Uh, that data was for the 2023-2024 fiscal year. We work on like a World of March calendar in government. Uh and why that is, is because it took about a year and a half uh to get these documents from the government through the FYI process. And that's what's in the story we're talking about today.

SPEAKER_02: 6:21

Well, I was gonna say it definitely took a lot longer than for you to explain how what you requested. It took months and months to get it. And in fact, I believe the inform the information commissioner actually had to get involved at some point. Before we get into details, let's talk about that because I don't think a lot of people understand how hard it is to wrestle this information out of the government sometimes. So you put in the request. Why was it delayed for so long?

SPEAKER_00: 6:39

Uh it seemed like a couple of different reasons. Uh the first, uh, it went to the Ministry of Health, and they're slow. I don't know what what I can say beyond it takes them longer than it takes most ministries to do these things. They have a lot of data and they're slow. Uh but uh the the province had also spun up its own independent ministry of long-term care separately from the minister, ministry of health. And during this year, in which I was more than a year that is waiting for these documents, they got their own FOI department. Uh, and then they got carriage of this thing. And they, you know, to their credit, these they contacted me uh where they they got it going. And to the government's credit, it decided that yes, this is public information that should be released according to the uh the freedom of information laws that we have here. The civil servants make those determinations and they're like, okay, we're gonna release it to you. But a couple of um they call them third parties, but what some of the long-term care homes were chains, and I don't know which ones, uh, objected to the release, filed an appeal, that went to an information commissioner, and it was eventually dropped, and we have the data.

SPEAKER_02: 7:45

Yes, yeah. Well, it's what definitely you're very patient. Um, and I think your hunch obviously was right too, because when you've got the when you received the data, it did show that some were doing very well and some were not doing so well. What struck you about the data?

SPEAKER_00: 7:56

Um that it did mirror what there was we saw going coming out of the pandemic. So when COVID hit, uh, the province released a lot of data about COVID, right? Who got COVID, um, who died, uh stuff like that. And they broke it down by long-term care homes. And so there was some academic research done uh that came to a few couple of big conclusions. Um, homes that were owned by uh private companies, uh particularly some of the big ones, had fared not so well. So they had bigger uh outbreaks, uh, more people had died. Um, and homes with that were older in their building and that had uh and then so and fewer staff were were some of the reasons that you a risk factor for having a bigger outbreak. That's not to say this didn't happen in homes that were run by municipalities or nonprofits. It's just when it came down to it, though some of the worst ones were generally concentrated in these for-profit chains, which I should probably explain to people because that sounds all a little bit confusing what the difference between a for-profit home and a nonprofit and a municipal home is.

SPEAKER_02: 9:05

Yeah, sure. Yeah, we'll scratch that question off the list. Go ahead. Yeah.

unknown: 9:08

Sorry.

SPEAKER_00: 9:11

Um there are there are three different ownership models. So you might find that your local municipality or region uh owns a long-term care home and runs a long-term care home, and some of your tax dollars might would go to it and uh subsidize it. Uh, you might find, and this is what the data showed, that they spend more on staffing uh than if they didn't have the tax base helping it out a little bit. You can also have homes that are run by not-for-profit organizations. These can be religious or cultural groups that run homes uh catering to specific, you know, seniors from specific religions or cultural affiliations, languages, and stuff like that. They tend to do fundraising uh to supplement their budgets as well. You can also have for-profit homes that are run as businesses, some of them private, some of them publicly traded, but for-profit businesses that do make a profit out of this. And all of these homes get the same funding from the province, with some differences for that aren't dependent on their ownership. Um, and they also charge the same things to residents. So um they just make it, they just make their business model work within that sort of rubric of government funding and that patients pay, uh, which is regulated by the province.

SPEAKER_02: 10:29

Interesting. So did your data show the same kind of thing? Say, for example, would for-profit homes have fewer staff in this data that you found?

SPEAKER_00: 10:36

Uh yes. So there to describe it, the ones at the very low end were all for profit. The ones with the lowest staffing that had missed the targets by the longest shots uh were for-profit. And there was one chain in particular that was uh overrepresented. At the top end, the ones with a lot of staffing, they was a mix. So municipal, some independent for-profit and not-for-profit homes had uh managed their homes to have a lot of hands-on care for their residents.

SPEAKER_02: 11:06

Your your article makes a point of reminding folks too that this is not, these aren't just numbers on a page. This is we're talking about quality of life of these people. Can you speak to that, Jess?

SPEAKER_00: 11:15

Yeah. So two of the people I talked to did a pretty good job of driving that home. They so when you're in long-term care, you generally have a pretty high level of need. That's why you're there. Um, and so what the lack of a lot of hands-on care time can mean is that you're maybe not turned in your bed as often as you should be and and get like a bed sore, right? That's a pretty common problem in long-term care. And it takes manpower to make sure that people don't get those. And if they do, that they're treated. Uh, they can mean more false, right? You need help to get around. If there's no help, you have more risk of a fall or a transfer from a bed to a wheelchair could go wrong, stuff like that. Um, and then one of the people I talked to was an MPP, but also a nurse who's worked in long-term care, said there's also just like the spending time, having conversations, making sure that the people who live in these homes have somebody to talk to when their family's able to visit if you know sometimes they aren't at all.

SPEAKER_02: 12:13

Great point. Um, what's fascinating about the piece too is as you always do, there's a great graphic that goes with this. It's very searchable, that anybody can go on to the Trillium, no matter what community you live in, and search the homes um in your area. Uh you should maybe lie when I ask you this question, but that you're so good at this stuff, Jess. But how does that how much work do you have to put in to kind of create that for people to use that tool? You should say it takes weeks and weeks.

SPEAKER_00: 12:37

No, it's not a click of a button. Um, it was a bit of math, a bit of spreadsheeting, uh several many hours of spreadsheeting to make sure that the data the data that comes from the ministry is uh analyzed and cleaned up. Uh for example, we have different quarters of data and they're going to spell the name of the same long-term care home differently for some reason in three different quarters. So cleaning that up to match. So it creates this thing on the in the story where you can go in and type in the name of a long-term care home that you're interested in, and then you can find the data for the that we have, whether they were below or above target or uh Jess, what's the uh reaction been to the story? Pretty strong. Um, it's been one that people have read a lot, and I've heard uh from all sorts of people. I've got a couple of people who've worked in long-term care who want to tell me what they experienced in the not so good things they experienced, those people who who at work are working in long-term care. Uh, I've also had uh a long-term care home come up uh say, like, I want to show you what success looks like. And they've invited me to come visit their home and I'm I'm gonna do that uh in a couple of weeks to see if they things going well. Uh, I also heard from, you know, like a person who's like, I'm gonna need long-term care home at some point, probably. How do I how do I find the right one? Some questions about this, all sorts of responses. Well, that's great.

SPEAKER_02: 13:54

And that that tool definitely helps people. It just if they're they're thinking about where where that if that's one of those things that the stats they want to look for, it's available. So there's not a lot of information like that. The the big question for me, Jess, is it took you 18 months to get it. Is the government committing to saying we're just gonna give you this data, we're gonna release this data on a regular basis now that we know it exists?

SPEAKER_00: 14:12

No. I have done a request for the following data and more up-to-date, and I hope that it comes quicker this time.

SPEAKER_02: 14:18

Aaron Powell Yeah, maybe it shouldn't. I mean, you've kind of paved the way uh for it to happen. I just I do want to point out that this all happened in the midst of all the amazing reporting your team, you and your team have been doing on the skills development fund. So in the middle of all the big scoops, you're getting all of a sudden this great uh deeper dive investigative piece lands as well. So, first of all, kudos for that to be able to juggle all that. I do want to ask you, uh we were you were on the show a couple weeks ago talking about the crowdfunding campaign that we've launched, uh raising funds to help with the cost of some of the FOI requests related to the Skills Development Fund. Can you give us a quick update on how that's going and what the reaction's been around Queen's Park?

SPEAKER_00: 14:51

Yeah, we surpassed what we called the first tier goal. So we sort of set a couple of goals for ourselves, raise the money we need to get all of these freedom of information requests paid for. All these have to do with this ongoing training fund controversy, where uh I won't go into the whole thing now, but we we did some requests for documents that are gonna be pretty expensive to get. So we're asking people to help pay for it. And if we hit that goal, we're gonna we're gonna publish these documents uh publicly and we're gonna make sure that our stories that we write about them are on paywalls for everybody to read. Uh so people have been listening. We we've raised enough to um pass our first tier goal and get this bunch of requests, and we're well on our way to getting towards the the second. And I hope that we get there because these are documents that are, I think, have the possibility to tell us a lot about this scandal that everybody's talking about at Queen's Park right now.

SPEAKER_02: 15:44

Absolutely. We'll be sure to link back to the where the people can donate or they can contribute and also some of the back coverage that explains what it is that we're doing.

SPEAKER_01: 15:51

All right. Uh anything else, uh Jess, you guys are working on that we should know about?

SPEAKER_00: 15:55

Oh, always, you know. You know, this government's taking over school boards. We've got stuff, we've got stuff on the go.

SPEAKER_01: 16:05

That's right. We shouldn't keep you any longer, Jess. Never a dull moment. There she is, uh Jessica Smith Cross, our editor-in-chief uh at the Trillium. Uh thanks as always, Jess.

SPEAKER_00: 16:13

Thanks, guys.

SPEAKER_01: 16:17

If I ever need help with my Excel spreadsheets, yeah. I think Jess is the one I'll be reaching out.

SPEAKER_02: 16:22

She's never I'm really giving you inside baseball, but she she teaches uh other journalists how to do what she does, and she's she's great at it. Yep. Having that conversation, uh it almost bring it brought me back because she mentioned the military going into the homes during cool. Do you remember that? I do remember that. They were they were releasing they were writing reports to their superiors as if they were on the front lines of Kandahar. Yes. Like they were and then they were they were also released under Freedom Information. And they were just you couldn't even believe what you were reading, just that this was Canada, this was Ontario, the conditions they were describing in these homes. And it kind of left the government with no choice but to act. Um as just pointed out, overall on average, the numbers are getting better in terms of right, but but as you know, just a smart decision to go and ask for the specific data because it shows that although some might be doing really well, there's a whole bunch that aren't doing very well. And I can tell you, you should check out this story. We'll put the link in our right up here. Sure. Just for the database alone. Go in there, wherever you live in Ontario, you can search for the local homes in your community and you can see where they measure up. And I'm sure, you know, we might have lit, you know, you have parents and you have your parents in these homes, you know, your relatives, people you love, or people you're thinking about, you're thinking about a loved one having to go to these homes. It's a great tool. There's, you know, it's just another piece of the research you should be doing.

SPEAKER_01: 17:31

And we will also link to the uh crowdfunding page so that you can check that out. And uh, if you feel like uh helping us out, uh that would be terrific. All right, uh, that's it for us tonight. Uh closer look at villagemedia.ca. Tonight's program, as always, produced by Derek Turner for Michael Friscalandi, our editor in chief here at Village Media. I'm Scott Sexmith. Appreciate your time tonight. Uh, we'll see you tomorrow night at seven, right here on Closer Look. Frisco and Scott's wardrobe, provided in part by Moore's Sault Ste. Marie.